Vermont County Profiles for Medical and Health Sciences Students/Residents

Transcription

1 s o u t h e r n V e r m o n t A H E C Vermont County Profiles for Medical and Health Sciences Students/Residents STUDENT AND RESIDENT EXPERIENCES IN COMMUNITY HEALTH The University of Vermont College of Medicine Office of Primary Care and Area Health Centers (AHEC) Program strives to provide the best possible educational experience to health professions students who spend time in community settings, particularly during rotations working with underserved populations. For many of our students there is a strong link between the quality of their educational experience and their choice of specialty or career path. Our hope is that through exposure to the special rewards that can come from working with our communities most needy members, our students will choose to devote some of their future practice to these populations. Purpose of the Handbook In order to fully understand a population, it is essential to understand the community in which they live. The purpose of this handbook is to provide health professions students with a community context for their rotations in practices outside the home base of the academic medical center. How the Handbook is Organized This handbook is organized by AHEC region and by county. The AHEC program (Area Health Education Centers) mission is the development of the healthcare workforce pipeline. AHECs across the country work with students from elementary school through practicing professionals to deliver health career teaching, advising, support, continuing education, and much more. The AHEC program in Vermont consists of a central program office at UVM and three regional centers in the Northeast (St. Johnsbury), the South (Springfield) and the Champlain Valley (St. Albans). For more information and links to each of the centers, see Grand Isle Chittenden Franklin Champlain Valley AHEC Lamoille Washington Orleans University of Vermont AHEC Program Caledonia Essex Northeastern Vermont AHEC For each region we have included information on the sociodemographic characteristics of the population and the health of the population. We have also included information on the health care resources that are available in the county and region, so that you can get a sense of what is available to the patients you will be seeing. Addison Orange We have included information on the leading employers in each region so that you can understand where people work and how they earn a living. Also included is information on the recreational opportunities not only so that you can understand what people do for fun, but also to encourage you to seek out some of these opportunities while you are there! If you have any suggestions about what to include in this handbook, please don t hesitate to let us know. Windsor Rutland Southern Vermont AHEC Bennington Windham Charles D. MacLean UVM Associate Dean for Primary Care

2 Population 625,741 (US Census Bureau, 2010) Geography Vermont is located in the northeastern part of the United States. Vermont is a small state and ranks 43rd in the United States. Only Delaware, New Jersey, Hawaii, and four New England states are smaller. Vermont s total land area is 9,609 square miles. This includes 333 square miles of water area (lakes, ponds, and streams) inside its borders. Vermont is about 157 miles long from the Canadian border south to Massachusetts. The northern boundary with Canada is about 90 miles in length. This is the widest part of the state. The boundary narrows to about 42 miles in the south along the Massachusetts border. Vermont is also one of six New England states and is the second largest in terms of area. Maine is by far the largest New England state. Its area is almost as big as Vermont and the other four New England states combined. Vermont s population is the smallest of the six New England states. Vermont is also the only New England state without an ocean coastline. Socioeconomic Indicators Risk Factors/Chronic Conditions Adult smokers... 15% Adult obesity... 22% Binge drinking... 17% Access to healthy foods*... 34% Children under 18 in poverty... 12% * Measured as a percentage of zip codes in the county with a healthy food outlet in the form of a grocery store, produce stand or farmer s market. Target value is 46%. Health Indicators Vermont is consistently one of the healthiest states in the nation. The United Health Foundation along with other collaborators ranks states on a wide variety of health indicators and also compiles an overall ranking. The 2010 edition places Vermont at the top of the list, having moved up from 20th place since The report notes that Vermont s strengths include its number one position for all health determinants combined which includes ranking in the top 10 states for a high rate of high school graduation, a low violent crime rate, a low percentage of children in poverty, high per capita public health funding, a low rate of uninsured population and ready availability of primary care physicians. Vermont s two challenges are low immunization coverage with 89.8 percent of children ages 19 to 35 months receiving recommended immunizations and a high prevalence of binge drinking at 17.3 percent of the population. Vermont has one of the highest percentages of the elderly due to a combination of factors, including low birth rate and out-migration of young adults. Almost 14% of the population is over age 65. Vermont has very good access to care, with an uninsured rate of about 10%, placing it in the top 7 states for this measure. tables.html Hospitals There are 14 hospital service areas in Vermont. They are geographically distinct, with some overlap of region. The hospitals of the state are represented by the Vermont Association of Hospitals and Health Systems. Seven of these hospitals are critical access hospitals, a federal designation that helps maintain emergency and hospital services in rural and remote areas. The tertiary care for Vermonters on the western side of the state is mostly delivered at Fletcher Allen Health Care, the academic medical center of the University of Vermont, and at Dartmouth Hitchcock Medical Center, the affiliate of Dartmouth Medical School on the eastern side of the state. A smaller proportion of patients may travel to Albany for their specialty health care needs. For services outside the region, Boston and New York are the most common sources of care. Health Care Reform in Vermont Vermont has a long history of health care innovation and reform, with a mission of Making quality and affordable health care available for all Vermonters. Some of the highlights of reform efforts include: The Dr. Dynasaur program provides coverage for pregnant women and all children up to the age of 18. Among the lowest rates of uninsured in the country. A statewide health care reform effort began in 2006, with a goal of improving not only the health of the population, but also reforming the way that health care is delivered. The guiding principles of the program are to increase access to health care, to improve quality and, because our current system is not sustainable, to contain costs. The Vermont Blueprint for Health is an integral part of the health reform efforts in the state. This partnership among public and private stakeholders is establishing Patient-Centered Medical Homes (also known as Advanced Primary Care Practices) across the state. In 2010 Vermont was one of eight states chosen to participate in a Medicare-sponsored demonstration project of the impact of this approach on quality and cost. Vermont is exploring options for additional reform of the health system. The so-called Hsiao Report was delivered to the Legislature in January 2011 and outlines a road map that includes a singlepayer option for health care financing. Vermont has made great strides in improving the health information technology of the state, with development of a health information exchange, incentives to practices for adoption and meaningful use of electronic medical records, and the development of an all-payer claims dataset to help analyze the health care system. For more information on Vermont s health care reform efforts visit

3 Primary Care in Vermont Health care reform efforts both nationally and regionally have focused on the importance of a robust and effective primary care system. There is an important link between primary care, improved health care quality and lower cost (Phillips 2010 Health Affairs 29; 806). It is very important to continuously improve and maintain the excellent primary care we have in Vermont. There are many ongoing efforts to train, recruit and retain the best primary care providers possible. They include educational programs in the UVM College of Medicine and the College of Nursing and Health Sciences, incentives such as loan repayment, practice support, insurance coverage for citizens, enhanced payment via programs such as FQHC, continuing education, teaching opportunities, the Vermont Academic Detailing Program, and many more. What is the National Health Service Corps? The National Health Service Corps is a program within HRSA that was established in 1972 to encourage primary care professionals to work in underserved settings (nhsc.hrsa.gov). As of September 30, 2009 it was comprised of a network of 7,000 primary health care professionals and 10,000 sites. To support their service, the NHSC provides clinicians with financial support in the form of loan repayment and scholarships. The NHSC has seen increases in federal funding and is expected to grow from 7,000 to over 10,000 professionals by The UVM Office of Primary Care and the VT AHEC Program help administer loan repayment programs and work with applicants to determine the best program for each individual. What is an FQHC? The federal government through the Health Resources and Services Administration (HRSA) has a formula by which areas in urban or rural settings are designated as medically underserved. This formula takes into account proportion of the population that is either elderly or below the poverty level, the infant mortality rate, and the number of primary care providers per 1000 people. Practices in medically underserved areas may apply to become Federally Qualified Health Centers (FQHCs). Community Health Centers (CHCs) and Rural Health Centers (RHCs) are examples of these federally designated clinics. You can find the FQHCs in a region of Vermont at As an FQHC, a practice receives higher reimbursement for providing medical services from Medicare and Medicaid. In return these centers must be available to see uninsured patients according to a sliding fee scale based on a patient s ability to pay. These are the so-called safety net providers that meet the needs of the medically underserved. Most states have not-for-profit advocacy organizations that support their FQHCs and help start new clinics where needed, known as Primary Care Associations or PCAs. The PCA that serves Vermont and New Hampshire is Bi-State Primary Care Association. What is a Freeman Medical Scholar? The Freeman Foundation, based in NYC, with deep roots to Vermont, has been a generous supporter of educational programs throughout the world. Through a gift to the UVM College of Medicine, the Foundation has provided scholarship support to College of Medicine students in return for a commitment to return to Vermont to practice, as well as educational loan repayment to recruit and retain physicians in Vermont of all specialties, including primary care. While there are no new scholarships or educational loan repayment awards, there are more than 200 physicians practicing in Vermont who have benefitted from this support, and many Freeman Medical Scholars are still in training and will practice in Vermont in the next decade.

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5 Franklin County Located in the northwestern corner of Vermont, Franklin County is steeped in rich traditions, a proud agricultural heritage, and natural beauty. population Franklin is the fifth largest county in Vermont with 47,979 persons. Its growth rate of 5.6% for fell between state and national rates of 2% and 8% respectively. The age of county residents as a percent of 2008 population was: < % % % % The number of elders grew more than any other age segment from : 65+ population % 85+ population % Socioeconomic Indicators Race, Ethnicity, and Language White, non-hispanic % American Indian/Alaska Native % Hispanic or Latino % Black (African American) % Asian % Native Hawaiian/Pacific Islander...no result Individuals resided in 16,765 households with an average size of 2.67 persons, above the state average of 2.44 persons. Families were a bit larger. In 1997, Franklin County had the highest population of residents with French or French Canadian ties, ranging from 32% to 60% per town. Many families continue to speak French. The Abenaki Nation of Missisquoi, St. Francis Soloki Band the largest group of native persons has been recognized by the state of Vermont and strives for federal recognition. The band has an office in Swanton and holds an annual festival open to the public. Hispanic and Latino persons include undocumented persons working on dairy farms % of residents were born outside of the United States of America, most in Canada or Europe. 6.5% of children over five and adults speak a language other than English at home. Income & Basic Needs Income is slightly above statewide figures, but the cost of housing requires even higher wages to make ends meet. Many working families must spend more than 30% of their income on housing and this is considered unaffordable. The cost of housing and utilities affects available funds for food, health care, transportation, higher education and saving. One third of Vermonters cannot become homeowners without subsidy. 6 Per capita income (2000) was $23,501, above Vermont per capita income of $20,625. Median household income was $53,032 in 2008, above $52,111 for Vermont. The wage needed to afford housing in Franklin County is $21.31 per hour, significantly above the state wage of $ In contrast, the average actual wage per job is $29,530 or $14.19 per hour. 9.9% of persons live in poverty, a little better than the state average of 10%. PLACE Franklin County is 637 square miles, with 54.9 square miles under water. The population density of 71.3 persons per square mile is slightly higher than the state average of Franklin County...47,949 Bakersfield town...1,402 Berkshire town...1,598 Enosburg town...2,698 Fairfax town...4,195 Fairfield town...1,916 Fletcher town...1,301 Franklin town...1,300 Georgia town...4,507 Highgate town...3,691 Montgomery town...1,053 Richford town...2,293 St. Albans city...7,250 St. Albans town...6,014 Sheldon town...2,303 Swanton town...6,

6 The Economy The county s north boundary on the US-Canadian border brought increased jobs and national attention since 9/11. Major employers include customs houses and US Immigration & Naturalization (including Homeland Security). With Lake Champlain to the west, Burlington to the South and Montreal to the north, the region serves as an important rail, ferry, and highway corridor. However, infrastructure needs outpace funding and limit potential activity. The number of farms decreased from 770 (2002) to 740 (2007) and hired farm workers dropped by 35% to 1,244 persons. Despite decreases, Franklin County continues to lead Vermont in dairy, maple production, and other agricultural products. Forecast for Growth: Natural resources, proximity to education and transportation, and community spirit combine to make the county a place ripe for growth. Jobs: In 2007, Franklin was one of only two Vermont counties with net job growth. The economic decline that has followed challenges residents security and economic wellbeing and brought many layoffs. Education: Resident ability to cope with the recession may be affected by education levels. While 85% have graduated high school compared to a state average of 82%, just 19% have a college degree, compared to the state average of 33%. Distance to Work: 51.2% of employed residents work in Franklin County while the rest must commute outside. Three-fourths of jobs at Franklin County employers are held by county residents while just one fourth are held by out of county commuters. 1 Employment Sectors: 1 Public Sector % (up.5% over 5 years) Services % (down 11.7% over 5 years) Goods % (down 14.1% over 5 years) Major employers by community: Cold Hollow Precision and Franklin Foods (Enosburg); Yankee Corporation (Fairfax); Bertek Systems, Century International Arms, and PBM Products (Georgia); Dexter Products (Highgate); Bum Wraps (Montgomery); and Blue Seal Feed and Kaytec (Richford). Additional employers include AN Deringer, Barry Callebault USA, Ben & Jerry s, Energizer, Messenger Print & Design, Mylan Technologies, Pyrofax, St. Albans Cooperative Creamery, and Superior Technical Ceramics (St. Albans); Abbey Group, Rock-Tenn, Viacheese, and Vermont Precision Tools (Sheldon); and Biocardel and Cargill Animal Nutrition (Swanton). Health 88% of Franklin County residents identify themselves as having good or excellent health. The remaining 12% feel they have poor or fair health, slightly higher than the state average of 11%. Risk Factors and Chronic Conditions 2 franklin County State of Vermont Adult smokers (youth rates declining)...22%...15% Adult obesity...26%...22% Childhood obesity...14%...12% Binge drinking...19%...17% Motor vehicle crash death rate...17%...13% Crime rate per thousand Second highest in VT 8 Access to healthy foods*...35%...34% Children under 18 in poverty...13%...12% Substance abuse treatment referrals are rising and the community is concerned about opiate use. * Measured as a percentage of zip codes in the county with a healthy food outlet in the form of a grocery store, produce stand or farmer s market. National target value is 46%; overall in VT is 34% Health Indicators 3 Access 12% of residents report having no health insurance at all. There is a shortage of 15 primary care physicians (full-time equivalent). Only 63% of Franklin County adults received influenza immunization in 2008, the worst rate statewide. Only 13% of adults do not have a usual primary care physician among the best outcomes in the state. Since one internal medicine physician retired in early 2009, the NOTCH Federally Qualified Health Center (FQHC) has opened a new site in St. Albans. NOTCH participates in a Health Resources and Services Administration Rural Health Outreach Grant, awarded to the Bi-State Primary Care Association to serve migrant farm workers. Women & Infants 92% of pregnant women receive prenatal care in the first trimester (above the state average of 90%). Teen birth rate among year-olds is 18.4 per thousand live births, above the state average of Low birth weight rate ( 5.5 lbs) is 6.9% (VT6.4 %). Number of women >40 years old who have had a mammogram is slightly below statewide average (76% vs. 77%).

7 Disease Rates Heart disease death rate is 209 per 100,000 population, second highest in the state (statewide average of 138). 24% of adults are obese, above the state average of 20% and the worst in the state. Stroke death rate of 41 per 100,000 is below the statewide average of 44 per 100,000. Diabetes-related deaths of 101 per 100,000 is above the statewide average of 91 per 100,000. Asthma hospitalizations among youth <18 is 3.2 per 10,000, significantly below the statewide rate of 9.1 per 10,000 and is one of the best outcomes in the state. In contrast, asthma rates among Abenaki persons is much higher. Chronic Obstructive Pulmonary Disease (COPD) deaths among people 45 and older is 139 per 100,000, significantly above the statewide average of 123 per 100,000. Primary Care Practices Family Practice, Internal Medicine, OB/GYN, Pediatrics and Psychiatry Enosburg/Enosburg Falls Cold Hollow Family Practice Enosburg Health Center Mousetrap Pediatrics Fairfax Fairfax Associates in Medicine Georgia Health Center Georgia Joseph D. Nasca, MD Richford Richford Health Center/Richford Dental Clinic of Northern Tier Center for Health (NOTCH)* St. Albans Amy B. Roberts, MD Franklin County Pediatrics Green Mountain OB/GYN H. Taylor Yates, Jr., MD Healthy First Maria Vijups, MD, PC Maryann Yeatts-Peterson, MD Mid-North Medical Group Mousetrap Pediatrics Northwest Counseling & Support Services Partners in Health Care St. Albans Health Center of Northern Tier Center for Health (NOTCH)* St. Albans Primary Care Swanton Swanton Health Center* * Federally Qualified Health Center (FQHC) Hospitals Northwestern Medical Center: Located in St. Albans, it is a 70-bed, not-for-profit, acute-care hospital. NMC provides primary and preventive care, surgical and specialty services, inpatient and outpatient care, 24-hour physician-staffed emergency services, and a walk-in clinic. NMC supports a number of primary care affiliates. Fletcher Allen Health Care: An academic health center with a service area that includes Franklin County and other areas totaling one million persons. FAHC has 458 staffed beds, more than 30 care sites and Vermont s only Level 1 Trauma Center. Key State & Community Agencies Free information and referral from the United Ways of Vermont. Community members who need to identify resources for any need can receive information by dialing toll-free from anywhere in Vermont works with TTY and provides interpreted services for limited English-speaking persons. Vermont Department of Health: St. Albans office provides information for the public and providers about current health issues online. Champlain Valley Office of Economic Opportunity (CVOEO): Operating throughout the northwestern region to provide food shelf, home weatherization, tenant support, mobile home assistance, Head Start, housing assistance, emergency fuel assistance, food stamp outreach, community garden and farm-tofamily voucher programs, tax filing and other form preparation services, information, and advocacy for low-income persons. The agency served more than 8,000 households last year. Champlain Valley Agency on Aging: Provides information and referral for all seniors and their families/supporters, case management for frail elders and certain younger adults with physical disabilities, and administers other Older American Act programs for the region. Call an Agency on Aging toll free from anywhere in Vermont at The Economic Services Division: The Vermont Department of Children and Families provides outreach, eligibility determination, and benefits administration for all state and federally funded basic and health needs programs. The Division just transitioned to a phone-based client services system which can be accessed 24/7 at Transactions that require a discussion with a staff person must be made between 7:45 am and 4:30 pm Monday through Friday by calling the same number. Franklin-Grand Isle United Way: Serving the islands of Grand Isle County as well as Franklin County it provides information about volunteer opportunities, supports a community health partnership, and provides funding to member agencies and youthdirected programs.

8 Mandated Reporting Vermont mandates licensed and allied health workers, educators, and certain other persons to report suspected abuse, neglect, or exploitation of children, vulnerable adults, and elders. Agencies and/or practices usually have a protocol for coordinating reports. However, Vermont state law holds you individually responsible for making a report if in your judgment you believe there is reason to suspect abuse, neglect, or exploitation. To learn about reporting requirements regarding children, visit Vermont Department of Children and Family Services Child Protection ( page. To make a report of suspected abuse or neglect call To learn about reporting requirements regarding vulnerable elder or disabled adults, visit Vermont Department of Disabilities, Aging and Independent Living Adult Protective Services ( To make a report of suspected abuse, neglect, or exploitation call or Northwestern Counseling and Support Services: Providing treatment and services to children and adults with chronic mental health, developmental disabilities, substance abuse problems, and other mental health and medical psychiatric needs. Call (802) Media, Recreation & Leisure Many radio and television signals originating from outside the county are received in much of Franklin County. The extreme northeast and northwest parts of the county have less reception options. Cell telephone signal weakens or is spotty in many parts of the county. News St. Albans Messenger: Daily newspaper includes local news and calendar of community events. Recreation Burton Island State Park: St. Albans Collins-Perley Sports and Fitness Center: St. Albans Center/ Mississquoi Natural Wildlife Refuge: Swanton Mississquoi Valley Rail Trail: More than 20 miles of trails for biking, walking, skiing, and more. St. Albans and surrounding area Vermont State Parks: Online at Find a State Park. Culture and Leisure Attractions Abenaki Tribal Museum & Cultural Center: Swanton The free library system: Visit the library catalog page for Vermont to click on links to the library nearest you. Vermont libraries have free Internet service and community activities. Hours vary and may be limited to certain days of the week in rural towns. The Opera House: Enosburg Falls Vermont Maple Festival: St. Albans 1 Vermont Department of Labor, Vermont Economic and Demographic Profile Series 2009, 2007 data 2 From County Health Rankings, a project of Robert Wood Johnson Foundation in collaboration with the University of Wisconsin Population Health Institute 3 The Health Status of Vermonters, March 2008, Vermont Department of Health, See Appendix, county data. 4 Primary Care Survey for the Champlain Valley 2011, Champlain Valley Area Health Education Center Census of Agriculture, County Profile: Franklin County, Vermont. 6 Between a Rock and a Hard Place: Housing and Wages in Vermont, 2009 Vermont Housing Finance Agency 7 US Census, Vermont Quick Facts 2008 for Franklin County, Vermont. 8 Community Needs Assessment 2009, Franklin/Grand Isle United Way 9 French Canadian and French Ancestry by Town, Canadian Studies Program, University of Vermont,

9 Chittenden County Located in the heart of the Champlain Valley in western Vermont, Chittenden County is Vermont s most populous area. Chittenden County hosts the University of Vermont and several institutions of higher learning. Its communities are diverse in size and organization, including gores, villages, towns and Vermont s largest city. The Champlain Valley Area Health Education Center, located in St. Albans, improves access to quality health care by working with community and academic partners to support healthcare workforce development through recruitment, retention and continuing education of health care professionals. The Champlain Valley AHEC region consists of the four counties of northwestern Vermont: Addison, Chittenden, Franklin, and Grand Isle. population Chittenden is Vermont s most populous county with 152,782 persons. Its growth from was 3.9%, between the state and national growth rates of 2% and 8%, respectively. The age of county residents as a percent of 2008 population was: < % % % % The segment of elders age 85 and older is the fastest growing in Vermont and in the region. 18,331 persons live with one or more disabling conditions. Socioeconomic Indicators Race, Ethnicity, and Language Chittenden County has the most ethnically diverse population in Vermont. The greatest proportion of the minority population can be found in Chittenden County. Of Vermont s 19,619 total minority populations of all ages, 7,125 (36.3%) reside in Chittenden County. The majority of Vermont s minority older adults also reside in Chittenden County. White, non-hispanic % American Indian/Alaska Native... <1.0% Hispanic or Latino % Black (African American) % Asian % Native Hawaiian/Pacific Islander... <1.0% Individuals resided in 50,456 households with an average size of 2.47 persons, virtually the same as the state average of 2.44 persons. As of 1990, nearly half the towns in Chittenden County included 40% or more of residents with French or French Canadian ties ( Some members of these families continue to speak French. Chittenden County is home to initiatives to assure the full participation of minorities and all groups in the community, such as the Social Equity Investment Project (SEIP) at the City of Burlington Community and Economic Development Office (CEDO) ( The program is identifying emerging leaders from all backgrounds. Some work in the program through the AmeriCorps initiative. As SEIP reminds all citizens, We all want the same things. Some minority leaders were interviewed in a Seven Days article ( in The University of Vermont s new Davis Center is home to programs that support the inclusion of students from diverse backgrounds ( and greater ties between minority communities and the University. Chittenden County is now the only county in which refugees are resettled within Vermont. Vermont Refugee Resettlement Program ( is the hub of support for the first months and years of arrival. Community Health Center-Burlington, the International Clinic at UHC Pediatrics, and Maitri Health Care for Women serve the largest numbers of newly arrived refugees in the community. For the last two decades, New Americans had told service providers and the state of Vermont that family is the preferred support, and that aging in place means living with or receiving help from family members as an alternative to nursing home. Those preferences still prevail, but service needs are becoming more complex as some families have lived in the region for decades and are beginning to struggle with how to age in place or support a family member given the complexities of employment, commuting, and western lifestyles. Other Languages Spoken at Home: 8% of children over five and adults speak a language other than English at home. Burlington School District ( php) has a cultural diversity resources page with helpful links and also maintains a vigorous home-school liaison program. The communities of Winooski, South Burlington, and Essex are also more diverse than most Vermont schools. 9

10 Champlain Valley AHEC maintains a Cultural Competency for Health Care Practitioners manual online ( CulturalCompetency.htm) in partnership with the Freeman Medical Scholars Program. Income and Basic Needs Income is higher in this region, but the cost of housing requires even higher wages to make ends meet. Many working families must spend more than 30% of their income on housing and this is considered unaffordable. The cost of housing and utilities affects available funds for food, transportation, health care, higher education and saving. One third of Vermonters cannot become homeowners without subsidy. Per capita income (2000) was $23,501. Median household income was $61,230 in 2008, above the statewide median of $52,111. The wage needed to afford housing in Chittenden County is $21.31 per hour, significantly above the state wage of $17.57 and reflecting higher home values, one of the tightest housing markets in the country, and the competition for affordable housing between a large student population and permanent residents. About half of Vermont households below median income do not earn a fair housing wage. 9.6% of persons live in poverty, just below the state average of 10%. Place Champlain County is 620 square miles with 539 square miles of land and 80.6 square miles under water. The population density of 282 persons per square mile is far higher than the state average of The county includes the only area in Vermont that meets the federal definition of a Metropolitan Statistical Area, yet is often too small to be able to replicate planning and service solutions that work in other metropolitan areas of much greater scale. Chittenden County...152,782 Bolton town...1,000 Buels gore Burlington city...38,897 Charlotte town...3,761 Colchester town...17,237 Essex town...19,649 Hinesburg town...4,629 Huntington town...1,951 Jericho town...5,190 Milton town...10,714 Richmond town...4,160 St. George town Shelburne town...7,146 South Burlington city...17,574 Underhill town...3,082 Westford town...2,229 Williston town...8,430 Winooski city...6,429 The Economy The county s proximity to interstate highways, rail systems, Lake Champlain, natural resources, and institutions of higher learning make it an area often ranked as one of the most livable places in the nation. With Lake Champlain to the west, Rutland and Bennington to the South and Montreal to the north, Chittenden County and the Lake Champlain region serve as an important rail, ferry, state highway and interstate highway corridor. Local disagreements about the potential impact of highway and other development on natural and social environments sometimes delay infrastructure projects (especially highways), affordable congregate housing, and business expansions. Forecast for Growth: The Lake Champlain Chamber of Commerce ( and other planning groups hold an optimistic growth outlook. Jobs: In 2007, 85,600 persons were employed and 3.3% unemployed. With the current recession, numbers and trends are changing dramatically. Education: The area meets the average high school graduation rate of 82% but lags behind the desired 92% target. 45% have a college degree, compared to the state average of 33%. Distance to Work: The average distance to work is below many other state commutes at 19.7 minutes. A small public transit system that does not serve the entire county limits opportunities for lowest income citizens. 1 Employment Sectors: 1 In recent decades, the economy s production of goods has decreased in relation to the production of services as the region continues to become more densely populated. Public Sector % Services % Goods % Major employers: Include recognizable names such as the State of Vermont, Burton Snowboards, Fletcher Allen Health Care, Gardener s Supply Company, Green Mountain Coffee Roasters, I.B.M., Martin Marietta, and Seventh Generation. Ben & Jerry s began as a micro-enterprise here and the area continues to generate many small and mid-level firms. The national local-vore movement has strong ties to Vermont and has led to many artisan and small scale agricultural ventures. Many producers sell or display at City Market Co-op or Burlington Farmers Market (Saturday mornings, late spring, summer and early fall). 10

11 Health Chittenden County residents are often described as having the best health status and access in the state of Vermont. In the big picture, consumers/patients seem to agree: just 8% describe themselves as in poor or fair health, compared to an average of 11% of Vermonters. For details about Vermonters health and wellbeing against state goals, visit the Vermont Department of Health annual health status update. Additional perspectives about challenges to elder health and wellbeing are also included in the Vermont Department of Disabilities, Aging & Independent Living State Plan on Agin.g Risk Factors and Chronic Conditions 2 Chittenden County State of Vermont Adult smokers (youth rates declining)..15%...15% Adult obesity...19%...22% Childhood obesity...8%...12% Binge drinking...18%...17% Motor vehicle crash death rate...9%...3% Crime rate per thousand Access to healthy foods*...54%...34% Children under 18 in poverty...8%...12% * Measured as a percentage of zip codes in the county with a healthy food outlet in the form of a grocery store, produce stand or farmer s market. The national target value is 46% and Vermont averages 34%. For Chittenden County, many providers note that many health food outlets are expensive and lower cost options are adequately served by public transportation systems. This had led to significant local controversies about the placement of affordable grocery stores and transit routes, and led to changes in food offerings at City Market Cooperative in Burlington. Health Indicators 3 Access 10% of residents report having no health insurance at all. 3 In aggregate, Chittenden County is considered to be in oversupply of primary care physicians. However, more than half of internal medicine physicians were not accepting or were limiting new patients and there are significant and serious waits for primary care for many populations in many parts of the county. Efforts continue toward establishment of a Federally Qualified Health Center (FQHC) for southern Chittenden County/northern Addison County. Women & Infants 91% of pregnant women receive prenatal care in the first trimester about the same as the state average of 90%. Number of women >40 years old who have had a mammogram is the same as the state average of 77%. Disease Rates Heart disease death rate is 159 per 100,000 population, which is above the statewide average of % of adults are obese, below the state average of 20% and the best status in the state. Stroke death rate of 42 per 100,000 is below the statewide average of 44. Diabetes-related death rate of 92 per 100,000 is above the statewide average of 91 per 100,000 and significantly worse than the best performers in the state (at 69 and 80 per 100,000). More adults than average are screened for diabetes at 89%, compared to the state average of 87%. Chronic Obstructive Pulmonary Disease (COPD) deaths among people 45 and older is 126 per 100,000, slightly above the statewide average of 123. Primary Care Practices Family Practice, Internal Medicine, OB/GYN, Pediatrics and Psychiatry Chittenden County includes forty-seven primary care practice sites but just one federally qualified health center in the Community Health Center of Burlington. While the county has the highest number of primary care providers per capita in the state, access remains a problem for many. Shortages of geriatricians and internal medicine physicians mean less care for adults, especially seniors. Frequent restrictions on practices accepting new patients or new patients with Medicaid/Medicare mean that finding a new doctor can be a problem, especially if you pay with public programs. Vermont has a network of elder care clinicians providing mental health support out of Vermont s Community Mental Health Centers. Chittenden County is served by the Howard Center, which provides care for acute and chronic mental illness for people of all ages, substance abuse treatment services, and services for individuals with developmental disabilities. Hospitals Fletcher Allen Health Care: is an academic health center based in Burlington with satellites in many communities. Its service area extends beyond Vermont to reach a population totaling one million persons. FAHC has 458 staffed beds, more than 30 care sites and Vermont s only Level I Trauma Center. Chittenden County includes a Champlain Long Term Care Community Coalition comprised of consumers, service providers and local leaders that works to identify needs and improve service options available to seniors, people with disabilities and their allies. Students and the public are welcome at its meetings. Contact Champlain Valley AHEC for current coalition contact information

12 Key State & Community Agencies 2-1-1: Free information and referral from the United Ways of Vermont. Community members who need to identify resources for any need can receive information by dialing toll-free from anywhere in Vermont works with TTY and provides interpreted services for limited English-speaking persons. Vermont Department of Health: Offices in Burlington, provides information for the public and providers about current health issues online. Champlain Valley Office of Economic Opportunity (CVOEO): operates throughout the northwestern region to provide food shelf, home weatherization, tenant support, mobile home assistance, Head Start, housing assistance, emergency fuel assistance, food stamp outreach, community garden and farm-to-family voucher programs, tax filing and other form preparation services, information, and advocacy for low-income persons. Champlain Valley Agency on Aging: Provides information and referral for all seniors and their families/supporters, case management for frail elders and certain younger adults with physical disabilities, and administers other Older American Act programs for the region. Call an Agency on Aging toll free from anywhere in Vermont at Economic Services Division: The Vermont Department of Children and Families provides outreach, eligibility determination, and benefits administration for all state and federally funded basic and health needs programs. The Division just transitioned to a phone-based client services system which can be accessed 24/7 at Transactions that require a discussion with a staff person must be made between 7:45 am and 4:30 pm Monday through Friday by calling the same number. United Way of Chittenden County: Provides information about volunteer opportunities, supports a community health partnership, and provides funding to member agencies and youth-directed programs. Northwestern Counseling and Support Services: Provides treatment and services to children and adults with chronic mental health, developmental disabilities, substance abuse problems, and other mental health and medical psychiatric needs. Mandated Reporting Vermont mandates licensed and allied health workers, educators, and certain other persons to report suspected abuse, neglect, or exploitation of children, vulnerable adults, and elders. Agencies and/or practices usually have a protocol for coordinating reports. However, Vermont state law holds you individually responsible for making a report if in your judgment you believe there is reason to suspect abuse, neglect, or exploitation. To learn about reporting requirements regarding children, visit Vermont Department of Children and Family Services Child Protection page. To make a report of suspected abuse or neglect call To learn about reporting requirements regarding vulnerable elder or disabled adults, visit the Vermont Department of Disabilities, Aging, and Independent Living, Adult Protective Services at To make a report of suspected abuse, neglect, or exploitation call or Media, Recreation & Leisure The county enjoys the best telecommunications access in the state. Cell phone transmission challenges can occur in higher elevations, particular in areas of Camel s Hump. News Burlington Free Press: Daily newspaper, including calendar of events. Seven Days: Weekly newspaper, including an interactive, searchable calendar of events. The Cynic: The weekly student newspaper of the University of Vermont. Center for Media and Democracy: Includes links to news resources for groups that are underrepresented in mainstream outlets. Vermont Public Radio: Broadcasts at FM and streams on the web. Recreation The City of Burlington Parks and Recreation Department: Maintains many public resources. Most other Chittenden County towns also have local departments or programs. Contact the Champlain Valley AHEC office for referrals. The Lake Champlain Bikeway: Popular in summer months. The Vermont Outdoor Guide Association: Resources for hiking and walking in Chittenden County. Vermont State Parks: Online at Find a State Park

13 Culture & Leisure Attractions Seven Days: the most comprehensive listing of cultural resources and current events in the region. The free library system: Visit the library catalog page for Vermont to click on links to the library nearest you. Vermont libraries have free Internet service and community activities. Hours vary and may be limited to certain days of the week in rural towns. The Flynn Center for the Performing Arts: Live performances, classes and an art gallery. It also increases public awareness of regional offerings through its regional ticketing service and calendar. Colleges & Universities Burlington College is an independent, progressive liberal arts college located in Burlington that offers 5 majors for two-year Associate and four-year Bachelor of Arts degrees, as well as several professional certificate programs. The non-profit institution serves 180 students. Champlain College: A private college located in Burlington s beautiful Hill section neighborhood. It serves 2,000 students who select from among thirty undergraduate majors and seven graduate programs. Community College of Vermont: A public, two-year, open-admissions institution that provides degree, transfer, occupational, and continuing education opportunities. It is a member of the Vermont State Colleges system and has 12 sites around the state, including one in Winooski. Saint Michael s College: A Catholic liberal arts college located on a 440-acre campus in Colchester, north of Burlington. It has more than 2,000 undergraduates and 500 graduate students in 34 major programs. The University of Vermont: A public university located on an historic Burlington campus. Founded in 1791 the same year Vermont became a state it is the fifth college established in New England. It has nearly 11,000 undergraduate and more than 2,000 graduate, medical, nursing, and allied health students who choose from among 100 Bachelor s degree programs, 54 Masters and 22 doctoral programs, and an M.D. program. 1 Vermont Department of Labor, Vermont Economic and Demographic Profile Series 2009, 2007 data 2 From County Health Rankings, a project of Robert Wood Johnson Foundation in collaboration with the University of Wisconsin Population Health Institute www. countyhealthrankings.org/vermont/caledonia/24 3 The Health Status of Vermonters, March 2008, Vermont Department of Health, See Appendix, county data. 4 Primary Care Survey for the Champlain Valley 2009, Champlain Valley Area Health Education Center. 13

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15 Grand Isle County Located in northwest Vermont on Lake Champlain, Grand Isle County is steeped in proud island culture and natural beauty. population Grand Isle County is the smallest county in Vermont with 7,560 persons. Its growth rate of 9.5% for is significantly above the state and national rates of 2% and 8% respectively. The age of county residents in 2008 was: < % % % % The county is the fastest growing of any in Vermont. The 40- to-59-year-old segment had an 83% growth rate between 2000 and 2008, followed by those ages at 34%. While working to address critical needs for current elders, local planners are also focused on how to meet the demands of future elders. Socioeconomic Indicators Race, Ethnicity, and Language Census data shows the following racial or ethnic heritage of residents: White, non-hispanic % American Indian/Alaska Native....7% Hispanic or Latino....8% Black (African American)....2% Asian....6% In 1997, about half the residents of the northern towns of Isle LaMotte and Alburg had French or French Canadian ties ( Many families continue to speak French at home. The Abenaki Nation of Missisquoi, St. Francis Soloki Band ( the largest group of native persons has been recognized by the state of Vermont and strives for federal recognition. The band has an office in Swanton and holds an annual festival open to the public. Hispanic and Latino persons include undocumented persons working on dairy farms ( and migrant workers who work at apple and other orchards on a seasonal basis. 4.2% of residents were born outside of the United States of America. The most common European ancestral ties include French, English, Irish, German, and Scottish identification. 5.7% of children over five and adults speak a language other than English at home. Income & Basic Needs While some economic indicators are better than state averages, half the county s residents struggle to afford housing. The cost of housing and utilities affects available funds for food, transportation, health care, transportation, higher education and saving. 6 Island geography provides unique challenges to accessing services, particularly in winter. Per capita income (2000) was $22,207, above Vermont per capita income of $20,625. Median household income was $57,435 in 2008, above $52,111 for Vermont. The wage needed to afford housing in Grand Isle County is $21.31 per hour significantly above the state average affordable housing wage of $ % of persons live in poverty, fewer than the state average of 10%. PLACE Franklin County is 637 square miles, with 54.9 square miles under water. The population density of 71.3 persons per square mile is slightly higher than the state average of Grand Isle County...7,560 Alburg town...1,402 Grand Isle town...1,598 Isle LaMotte town...2,698 North Hero town...4,195 South Hero...1,916 The Economy The welfare of the region is uniquely tied to Lake Champlain. The region has important investments in agriculture and tourism. Forecast for Growth: Natural resources, proximity to education and transportation, and community spirit combine to make the county a place ripe for growth. The county is experiencing a growth in the number of people establishing home-based professional businesses. Unemployment: Grand Isle County has one the state s lowest unemployment rates at 6.2%. Education: 34% have graduated high school compared to a state average of 32%; 24% have a college degree. 15

16 Distance to Work: 57.2% of workers are employed outside the county. Out-of- county workers spend on average 50% more time commuting to work than other Vermonters. The mean commute time to work is 33.4 minutes. Major Employment Sectors: Education, Health, & Social Services % Manufacturing... 15% Construction % Retail Trade % Health Most Grand Isle County residents identify themselves as having good or excellent health. Just 8% feel they have poor or fair health, which is below the statewide average of 11%. Elders who need long-term care combined with housing have no local options to move into a residential care home or congregate housing site with a supportive services program. No other county in Vermont is without options to support local aging in place. Risk Factors and Chronic Conditions 1 grand isle County State of Vermont Adult smokers (youth rates declining)...17%...15% Adult obesity...25%...22% Childhood obesity...16%...12% Binge drinking...9%...17% Motor vehicle crash death rate...9%...13% Crime rate per thousand Access to healthy foods*...40%...34% Children under 18 in poverty...12%...12% * Measured as a percentage of zip codes in the county with a healthy food outlet in the form of a grocery store, produce stand or farmer s market. National target value is 46%; overall in VT is 34% Health Indicators Access 16% of residents report having no health insurance at all 3 There is a shortage of five (full-time-equivalent) primary care physicians Only 62% of Grand Isle County adults received influenza immunization in (The state average was 66%.) 16% of adults do not have a usual primary care physician. All primary care sites accept new patients, including those participating in Medicaid or Medicare new patients. The NOTCH Federally Qualified Health Center (FQHC) participates in a HRSA Rural Health Outreach Grant awarded to the Bi-State Primary Care Association to serve migrant farm workers. In addition to all other services, Keeler Bay practice offers farm visits in partnership with UVM College of Medicine residents and biweekly clinics. Women & Infants 2 91% of pregnant women receive prenatal care in the first trimester. (Statewide average is 90%) Low birth weight rate ( 5.5 lbs) is 8.1% (VT 6.4%) Disease Rates Heart disease death rate is 226 per 100,000 population, the highest rate in the state (Statewide average of 138) 25% of adults are obese (Statewide average of 22%) Diabetes-related deaths of 78 per 100,000 (Statewide average of 91 per 100,000). Asthma hospitalizations among youth <18 is 3.5 per 10,000, which is significantly below the statewide rate of 9.1 per 10,000 and is one of the best outcomes in the state. In contrast, the asthma rate among Abenaki persons is much higher. Chronic Obstructive Pulmonary Disease (COPD) death rate among people 45 and older is 230 per 100,000, the highest rate in the state. (Statewide average is 123 per 100,000). Primary Care Practices Family Practice, Internal Medicine, OB/GYN, Pediatrics and Psychiatry Alburg Alburg Health Center* South Hero Keeler Bay Family Practice * Federally Qualified Health Center (FQHC) Hospitals Northwestern Medical Center: A 70-bed, not-for-profit, acutecare hospital in St. Albans. NMC provides primary and preventive care, surgical and specialty services, inpatient and outpatient care, 24-hour physician-staffed emergency services, and a walk-in clinic. NMC supports a number of primary care affiliates. Its St. Albans hub is the primary hospital for the northern Grand Isle County towns of Alburg, Grand Isle, and Isle LaMotte. Fletcher Allen Health Care: An academic health center with a service area that includes portions of Grand Isle and Franklin counties, as well as other areas totaling 1 million persons. FAHC has 458 staffed beds, more than 30 care sites and Vermont s only Level I Trauma Center. Its Burlington hub is the primary hospital service area for the southern Grand Isle County communities of North Hero and South Hero

17 Key State & Community Agencies 2-1-1: Free information and referral from the United Ways of Vermont. Community members who need to identify resources for any need can receive information by dialing toll-free from anywhere in Vermont works with TTY and provides interpreted services for limited English-speaking persons. The Vermont Department of Health: A district office in St. Albans serves Grand Isle County residents. Online information about current health issues and resources is available for the general public and for providers. Champlain Valley Office of Economic Opportunity (CVOEO): Operating throughout the northwestern region to provide food shelf, home weatherization, tenant support, mobile home assistance, Head Start, housing assistance, emergency fuel assistance, food stamp outreach, community garden and farm-to-family voucher programs, tax filing and other form preparation services, information, and advocacy for low-income persons. The agency served more than 8,000 households last year. Champlain Valley Agency on Aging: Provides information and referral for all seniors and their families/supporters, case management for frail elders and certain younger adults with physical disabilities, and administers other Older American Act programs for the region. Call an Agency on Aging toll free from anywhere in Vermont by dialing C.I.D.E.R.: A private, non-profit membership organization of Champlain Islanders Developing Essential Resources, with an emphasis on addressing needs of islanders who are elderly or have a disability. Through innovative direct services and partnerships the group provides information and referral, transportation, meals, housing, reassurance and other supports. The agency is a member of the local United Way. The Economic Services Division: The Vermont Department of Children and Families provides outreach, eligibility determination, and benefits administration for all state and federally funded basic and health needs programs. The Division just transitioned to a phone-based client services system which can be accessed 24/7 at Transactions that require a discussion with a staff person must be made between 7:45 am and 4:30 pm Monday through Friday by calling the same number. Franklin-Grand Isle United Way: Serves the islands of Grand Isle County as well as Franklin County and provides information about volunteer opportunities, supports a community health partnership, and provides funding to member agencies and youth-directed programs. Mandated Reporting Vermont mandates licensed and allied health workers, educators, and certain other persons to report suspected abuse, neglect, or exploitation of children, vulnerable adults, and elders. Agencies and/or practices usually have a protocol for coordinating reports. However, Vermont state law holds you individually responsible for making a report if in your judgment you believe there is reason to suspect abuse, neglect, or exploitation. Vermont Department of Children and Family Services Child Protection: Learn about reporting requirements regarding children. To make a report of suspected abuse or neglect call Vermont Department of Disabilities, Aging and Independent Living Adult Protective Services: Learn about reporting requirements regarding vulnerable elder or disabled adults, visit. To make a report of suspected abuse, neglect, or exploitation call or Northwestern Counseling and Support Services: Provides treatment and services to children and adults with chronic mental health, developmental disabilities, substance abuse problems, and other mental health and medical psychiatric needs. Call (802) Media, Recreation & Leisure Cell telephone signal is limited in many parts of the county. News Burlington Free Press The Islander Recreation The county is home to several state parks: Alburg Dunes State Park Burton Island State Park Grand Isle State Park Kill Kare State Park Knight Island State Park North Hero State Park Sand Bar State Park Woods Island State Park Lake Champlain Bikeways

18 Culture & Leisure Attractions Lake Champlain Islands Events Calendar: For local events. The free library system: Visit the library catalog page for Vermont to click on links to the library nearest you. Vermont libraries have free Internet service and community activities. Hours vary and may be limited to certain days of the week in rural towns. Vermont Shakespeare Festival

19 Addison County Located in the southern Champlain Valley of Vermont, Addison County is known for open rolling farmlands, mountain towns, the smallest city in America and an inclusive community spirit. population Addison is the eighth largest of fourteen counties in Vermont with 36,760 persons. Its growth rate is 2.2% for , just higher than the state growth rate of 2% and below the national growth rate of 8%. <5... 5% % % % (VT average 13.9%) The segment of elders age 85 and older is the fastest growing in Vermont and in the region. 18,331 persons live with one or more disabling conditions. Socioeconomic Indicators Race, Ethnicity, and Language Census data shows the following racial or ethnic heritage of residents: White, non-hispanic % American Indian/Alaska Native % Hispanic or Latino % Black (African American) % Asian % Individuals resided in 16,654 households with an average size of 2.55 persons, compared to the state average of 2.44 persons. Nestled in the lower Champlain Valley and bordered by the Adirondack Mountains in the west and the Green Mountains to east, Addison County is a close knit community of agricultural heritage Farming in Addison County has recently come to depend on a labor force that consists of undocumented persons working on dairy farms ( the majority of whom are Hispanic and Latino persons. 3.5% of residents were born outside of the United States of America. Income & Basic Needs Income in Addison County is higher than the state average, but buying a home in Addison County is difficult for many households as the gap between median house price and median household income is the fourth highest in the state. Per capita income in 2007 was $34,771, below the Vermont per capita income of $37,483. Median household income was $56,584 in 2008, (above the statewide median of $52,111). The wage needed to afford housing in Addison County is $16.65 per hour, slightly below the state wage of $ % of persons live in poverty, slightly below the state average of 10%. place Addison County is square miles. The population density of 46.7 persons per square mile is lower than the state average of Addison County...36,760 Addison...1,431 Bridport...1,248 Bristol...3,770 Cornwall...1,226 Ferrisburgh...2,692 Goshen Granville Hancock Leicester...1,010 Lincoln...1,270 Middlebury...8,205 Monkton...1,981 New Haven...1,820 Orwell...1,222 Panton Ripton Salisbury...1,105 Shoreham...1,295 Starksboro...1,924 Vergennes City...2,696 Waltham Weybridge Whiting

20 Health 90% of Addison County residents identify themselves as having good or excellent health. The remaining 10% feel they have poor or fair health, slightly lower than the state average of 11%. Risk Factors and Chronic Conditions 1 addison County State of Vermont Adult smokers...19%...19% Adult obesity...22%...22% Binge drinking...25%...17% Motor vehicle crash death rate...11%...13% Access to healthy foods*...33%...34% Children under 18 in poverty...10%...12% * Measured as a percentage of zip codes in the county with a healthy food outlet in the form of a grocery store, produce stand or farmer s market. National target value is 46%; overall in VT is 34%. Health Indicators 2 Access 12% of residents report having no health insurance at all. 76% of Addison County adults received influenza immunization in 2008, better than the state rate of 66%. Only 10% of adults do not have a usual primary care physician. (Statewide is 15%.) 3% of primary care physicians either limit or do not accept new patients. Women & Infants 89% of pregnant women receive prenatal care in the first trimester. (state average is 90%). Teen birth rate among year olds is 11.5 per thousand live births, better than the state average of Low birth weight rate ( 5.5 lbs) 5.1%. (VT 6.4 %) 78% of women >40 years old have had a mammogram, slightly above the statewide average of 77%. Disease Rates Heart disease death rate is 150 per 100,000 population, higher than the statewide average of % of adults are obese, one of the higher rates in the state, which averages 20%. Stroke death rate of 50 per 100,000 is above the statewide average of 44. Diabetes-related deaths of 109 per 100,000 is one of the highest in the state and well above the statewide average of 91 per 100,000. Asthma hospitalizations among youth <18 is 3.3 per 10,000 is significantly below the statewide rate of 9.1 per 10,000 and is one of the best outcomes in the state. Chronic Obstructive Pulmonary Disease (COPD) death rate among people 45 and older is 108 per 100,000, below the statewide average of Primary Care Practices Family Practice, Internal Medicine, OB/GYN, Pediatrics and Psychiatry Bristol Bristol Internal Medicine Mountain Health Center Shoreham Shorewell Clinic Vergennes Little City Family Practice Tapestry Midwifery Middlebury Addison Associates in OB/GYN Addison Family Practice Counseling Services of Addison County Middlebury Family Health Middlebury Pediatric & Adolescent Medicine Open Door Clinic Parton Health and Counseling Center Planned Parenthood of Northern New England Porter Internal Medicine Rainbow Pediatrics Hospitals Porter Hospital: Middlebury is a Critical Access Hospital founded in 1925, and offers comprehensive medical care and 24-hour emergency services. The Porter Hospital Medical Staff consists of more than 60 physicians offering primary care and an array of specialty medical care. Fletcher Allen Health Care: An academic health center with a service area that includes Franklin County and other areas totaling one million persons. FAHC has 458 staffed beds, more than 30 care sites and Vermont s only Level I Trauma Center. State & Community Agencies Information & Referral 2-1-1: Free information and referral from the United Ways of Vermont. Community members who need to identify resources for any need can receive information by dialing toll-free from anywhere in Vermont works with TTY and provides interpreted services for limited English-speaking persons. United Way of Addison County: Provides a one-page list of frequently used numbers. Champlain Valley Office of Economic Opportunity (CVOEO): Operates throughout the northwestern region providing food shelf, home weatherization, tenant support, mobile home assistance, Head Start, housing assistance, emergency fuel assistance, food stamp outreach, community garden and farm-to-family voucher programs, tax filing and other form preparation services, information, and advocacy for low-income persons. The agency served more than 8,000 households last year.